CULTIVATING CULTURAL CURIOSITY PATIENT CENTERED CARE Karen L. Busch, MA Director of Organizational Development Memorial Hospital

Objectives  Foster an awareness of one’s own culture, and how experiences shape hidden biases and prejudices  Differentiate between diversity, cultural competency and health care literacy  Demonstrate knowledge of cultural competence as it relates to health and illness  Acceptance of the on-going responsibility for one’s own education in cultural competence

“TO BE CULTURALLY COMPETENT PROVIDERS SHOULD NOT BE EXPECTED TO HAVE FULL KNOWLEDGE OF EVERY CULTURAL PRACTICE AND BELIEF.” Sahar Andrade, MB, BCh

Health Care Inclusion Umbrella DiversityCultural CompetencyHealth LiteracyLEP

Community Norms  Listen  Participate  Avoid side conversations  Honesty  Respect differences  Speak in the “I”  All voices heard  Assume good intent  “Ouch” “Oops” “Ahah” option  Embrace dissent and conflict  Work issues, not person  Trust process  Lean into discomfort 5

Implicit Bias created by cycle of socialization Patient Centered Care and Cultural Sensitivity

Pop Question What do we mean by culture?

Primary Characteristics of Culture Guide to Culturally Competent Care-Purnell  Age  Generation  Nationality  Race  Color  Gender  Religion  Education Status  Socioeconomic status  Occupation  Military status  Political beliefs  Urban verses Rural  Marital status  Parental status  Physical characteristics  Sexual Orientation  Gender issues  Immigrant status PrimarySecondary Characteristics

Cultural Competency Awareness  Demographics  Culture  Languages  Socioeconomic status  Access to services  How health information is received  How rights and protections are organized  What is considered a health problem  How symptoms and concerns about the problem are expressed  Who should provide treatment  What type of treatment given Knowing your patientsCulture can affect…

Self Awareness of Your Culture Pair Share  Values, Beliefs, ethics and life experiences  Something you enjoy about your family’s culture  An occasion with close friends or family/in-laws that made you question your family culture  How our own perspective impacts the patient experience

Addressing Cultural Competence Group Share  What can we do to improve the patient experience?  Changing our mental model of healthcare

Common Myths  Individual differences exist even within the same group of people  Similar appearances do not mean people share the same culture  Sharing a language or nationality does not mean sharing the same culture  Sharing the same religion does not mean you share similar cultures

Generalizations vs. Stereotyping  Generalizations  Common trends and patterns  Beliefs and behaviors shared by a certain group  Positive  Stereotyping  Roots in prejudice  Unjustified negative attitude  Based on own personal biases

Using High Quality Inquiry in Health Care Exploring the views of others through questions  What do you prefer?  Help me understand your reasoning?  What are your priorities?  What are your thoughts about…?  Could you give me an example?  What are your concerns or fears?

Patient Centered Interactions Is the ability to communicate with patients in a way that works well for them Ask open ended questions Non-medical jargon Listening skills Watch for non-verbal indicators of not understanding

Areas of Cultural Sensitivity  Communication  Language/Reading proficiency  Personal Space  Touching  Social Orientation  Time  Family Organization  Relationship to nature  Eye Contact/Gestures  Ethnicity/Country of Origin  Values/Beliefs/Customs  Spirituality  Religion

Key “Take-Aways”  Awareness of implicit bias  Self-knowledge  Using high quality inquiry  Intra and Cross-Cultural awareness  Respect core values  Cultural issues involve: age, gender, education and socioeconomic status as well as racial, ethnic, and religious differences  Nods and polite smiles do not mean effective communication  Medicine is a “language” which requires translation-no medical jargon  Medical decision making involves the family or community not just the individual patient  Involving the religious leader when appropriate Behind Every Task is A Human Being

Dimensions of Quality from the Institute of Medicine 2001  Safe  Effective  Patient-Centered  Timely  Efficient  Equitable 23

References Adams, M., Bell, L.A., Griffen, P., (2007). Teaching for Diversity and Social Justice. Taylor Francis Group, LLC Purnell, L.D.PhD, RN, FAAN., Guide to Culturally Competent Health Care. (2009). F.A. Davis Company HPOE Webinar Series -for-healthcare.htiml